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Arkymedic

Arkymedic

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Ok..

I am having some trouble with my IVs lately. I get a good flash but when I open the fluids my site is blown. I have tried everything short of doing a rotation in ER/OR to help resolve this ( and this is due to being in a different state that I am not allowed to practice in) for now. We use the old jelco caths and I thought I was doing ok then I started blowing them again... any suggestions or helpful hints? Thanks
 
Arkymedic said:
Ok..

I am having some trouble with my IVs lately. I get a good flash but when I open the fluids my site is blown. I have tried everything short of doing a rotation in ER/OR to help resolve this ( and this is due to being in a different state that I am not allowed to practice in) for now. We use the old jelco caths and I thought I was doing ok then I started blowing them again... any suggestions or helpful hints? Thanks
Click to expand...

Sounds like you're pushing the needle too far or deep into the vein. When you start an IV, it should be like landing a plane onto the vein, not dive bombing. If it's mostly older people you're having trouble with, be a little more gentle and don't use a restricting band if you don't have to because the back pressure created from it can sometimes blow a vein. Also, search around on other forums because I've seen tons of IV tips on all of them, especially nursing forums.


Oh, and remember, selection process is more important than skill. Select veins you can see and feel the best and make sure you know where the veins go anatomically. This is the real secret to a high success rate.
 
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It could also be you are stressing over it causing you to blow more than you normally would. It could also be a case of just getting the luck of the draw and having a few bad cases.

Either way no one is 100% first stick. Even the best will hit dry spells. I pride myself on working to be better than average and I have still fallen into the occasional rut.
 
Like others have described no one is perfect. Show me a person with 100% accuracy and I will show you someone that does not attempt very many. I myself have off days, and could not hit the side of a barn, then some-days could start one on a flea.

I have found many EMT students attempting too strong of an angle as well. Typically they attempt to initiate like they are going to give an IM, it should be no more than 20-30 degrees and sometimes almost parallel. Once you have blood return, introduce the needle w/catheter almost half way. If you do not, the catheter will have to be attempted to thread on its own, causing infiltration and crinkle. The other is not to "lacerate" the vein, by going to deep and downward... causing vessel disruption, and hence the "blowing" effect.

I have noticed as well many will go very slow, causing increased pain and tugging of the skin. Remember, veins have nerves and yes, even muscles (tunica media, adventia, intima) and when you stick.. yes, they can constrict and move. Be sure to stabilize the vein if possible with the opposite hand, while performing the veinapuncture.

Like all other skills, it takes practice to be successful. We are talking hundreds..

Good luck,
R/r 911
 
I don't have much experience in this, but all I can say is if it's going through the vein, try a lower angle, a bit more parallel with the skin. Another trick, stolen concept from an old sniper trick, that I also use for longer-exposure photography is to exhale right as you make the shot (or in this case, puncture the vein). Other than that, try to stabilize the vein, and your arm you're doing the injection with, by resting it on a stable surface (their forearm is great for this), and practice whenever you can.
 
Ridryder911 said:
Once you have blood return, introduce the needle w/catheter almost half way. If you do not, the catheter will have to be attempted to thread on its own, causing infiltration and crinkle. The other is not to "lacerate" the vein, by going to deep and downward... causing vessel disruption, and hence the "blowing" effect.
Click to expand...

That's a great one I forgot to mention. I've noticed many new ALS providers never get taught this in the classroom or ED rotation.
 
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